（阳明为疾胃家实是也胃实则谵语故谵语宜入阳明门）
成 谵者谓呢喃而语也又作谵谓妄有所见而言也斯皆胃中热盛上乘于心心为热胃则神识昏乱而语言谬妄也轻者
睡
中呢喃重者寤亦谬语经谓谵语独语狂语及语言不休与言乱者由其热之有轻重也（谵语错妄若与人言有次与独语如见鬼者
热之轻也狂言无所知识甚则至于喊叫与语言不休者热之甚也迨夫言乱乃狂言骂詈不避亲疏此为神明已乱难可复制其猖
狂也）谵语之由又自不同有火劫有汗出有下利有下血有燥屎在胃有三阳合病有过经有亡阳等谵语者俱已条具于后兹不及
赘诸如此者脉短则死脉自和则愈又身微热脉浮大者生逆冷脉沉不过一日死或气上逆而喘满或气下夺而自利皆为逆也
阳明胃实潮热宜下
阳明病谵语发潮热脉滑而疾者小承气汤主之因与承气汤一盏腹中转失气者更服一盏若不转失
气勿更与之明日不大便脉反微涩者里虚也为难治不可更与承气汤 阳明病谵语有潮热反不能食者胃中必有燥屎五六枚
若能食者但硬尔宜大承气汤下之 二阳并病太阳病罢但发热手足 汗出大便难而谵语者下之则愈宜大承气汤 阳明
病其人多汗以津液出胃中燥大便必硬硬则谵语小承气汤主之若一服谵语止勿更服
胃实汗多宜下
汗出谵语者必有燥粪在胃中此为风也须下之必过经乃可下下之若早语言为乱以表虚里实故下之则
愈宜大承气汤夫实则谵语虚则郑声（谵语者谓乱言无次数数更端也郑声者谓郑重频烦也只将一句旧言重叠频言之终日殷
勤不换他声也盖神有余则能机变而乱语数数更端神不足则无机变而只守一声也）伤寒四五日脉沉而喘满沉为在里而反发
其汗津液越出大便为难表虚里实久则谵语（成氏谓郑声为郑卫之声非是前已辩明）
火后
形作伤寒其脉不弦紧而弱弱者必渴被火者必谵语弱者发热脉浮解之当汗出愈 太阳病火劫汗后身黄小便难
身体枯燥头汗腹满微喘或不大便久则谵语（论见头汗）太阳病二日反躁乃熨其背而大汗出火热入胃胃中水竭躁烦必发谵
语十余日振栗自下利者此为欲解 少阴病咳咳而下利谵语小便难者被火气劫汗故也吐下汗温针后谵语柴胡证罢者此为
坏病知犯何逆以法治之（详见坏证）
汗后
伤寒脉浮自汗小便数心烦微恶寒脚挛急反与桂枝欲攻其表此误也若胃气不和谵语者少与调胃承气汤（方论见
厥）三阳合病腹满身重难以转侧口不吃而面垢谵语遗尿发汗则谵语下之则额上生汗生则逆冷若自汗出者白虎汤主之（论
见身重）伤寒四五日脉沉而喘满沉为在里而反发其汗津液越出大便为难表虚里实久则谵语大承气汤（见不大便）伤寒脉
弦头痛发热者属少阳少阳不可发汗发汗则谵语此属胃胃和则愈胃不和则烦而悸（见少阳病）发汗多亡阳谵语者不可下与
柴胡桂枝汤和其荣卫以通津液后自愈发汗多又重发汗者亡其阳谵语脉短者死脉自和者不死 诸逆发汗病微者瘥剧者言
乱目眩者死
下后
伤寒八九日下之胸满烦惊小便不利谵语一身尽痛不可转侧者柴胡加龙骨牡蛎汤（方论见惊）
热入血室
阳明病下血谵语者此为热入血室但头汗出者刺期门随其实泻之 然汗出则愈（腹满谵语脉浮紧者亦刺期
门太阳少阳并病发汗则谵语脉弦五六日谵语不止者宜刺期门）妇人中风发热恶寒经水适来得之七八日热除脉迟者身凉胸
满如结胸状者刺期门若昼则明了暮则谵语者无犯胃气及上二焦必自愈活人以小柴胡汤主之（论见妇人伤寒）
伤寒十三日不解过经谵语者以有热也当以汤下之若小便利者大盒饭硬而反下之脉调和者知医以丸药下之非其治也
若自下利者脉当微厥今反和者此为内实也调胃承气汤主之（成 伤寒十三日再传经尽谓之过经谵语者阳明胃热也当以诸
承气汤下之若小便利者津液偏渗大盒饭硬反下利者知医以丸药下之也下利脉微而厥者虚寒也今脉调和则非虚寒由肠虚
胃热协热而利也与调胃承气汤以下胃热 经文内实之实当作热注偏渗偏当作漏 此段有五反一对热与厥反汤与丸反便
硬与下利反脉微与脉和反药下与自利反小便与大便硬为一对读者宜细详之）
上下利谵语其曰脉调和而手足和小便利者阳也故用承气下之其脉当微厥及少阴但欲寐被火气劫汗谵语小便难者阴
也故当用补剂和之（但欲寐下利谵语俱见下利少阴条）
许 有人病伤寒下利身热神昏多困谵语不得眠或者见下利便以谵语为阴虚证予曰此亦小承气证众骇曰下利而服
小
承气仲景之法乎予曰此仲景之法也仲景云下利而谵语者有燥粪也属小承气汤而得解予尝读素问云微者逆之甚者从之逆
者正治从者反治从多从少视其事也帝曰何谓反治岐伯曰塞因塞用通因通用王冰注云大热内结注泻不止热宜寒疗结复须
除以寒下之结散利止则通因通用也正合于此（又何疑焉）
活 大便秘小便赤手足温脉洪数者必谵语也调胃承气汤 谵语不恶寒反恶热白虎汤 已得汗身和谵语者柴胡桂
枝汤 火迫而致谵语亦白虎汤
海 治老幼及虚人伤寒五六日昏冒言妄小便或淋或涩起卧无度或烦而不得眠并宜白虎汤加山栀一钱
斗 治热病及时疫心躁狂乱奔走状似癫痫言语不定久不得汗及时疫不知人事者以人中黄不拘多少入罐内泥封固
武
火半日去火候冷取出于地上以盆盖半日许研如面新汲水调下（三钱）或未退再服愈（人中黄即屎也）
吴 治伤寒热甚心烦有痰神昏谵语者以竹沥一盏生天花粉汁一盏服之或加好金子三五钱同煎妙按此诸方内热不
禁下者可用
补虚
素问云谵语者气虚独言也（娄全善云余用参 归术等剂治谵语得愈者百十数岂可不分虚实一概用黄连解毒大
小承气等汤以治之乎）难经云脱阳者见鬼（仲景谓亡阳谵语亦此义）
海 黄 汤治伤寒或时悲哭或时嬉笑或时太息或语言错乱失次世人疑作谵语狂言者非也盖神不守室耳两手脉浮
沉
不一举按全无力浮之损小沉之亦损小皆阴脉也之病甚者用调中丸或理中丸（方见前补养条）
丹 浦江郑兄年二十岁九月间发热头痛妄言见鬼医与小柴胡汤数帖热愈甚予视之形肥面色带白却喜筋骨稍露诊
其
脉弦大而数实脉本不实凉药所致此因劳倦成病与温补药自安遂以参术为君苓芍为臣黄 为佐附子一片为使与一帖而证
不减或曰脉既数大狂热而又大渴用附子误矣予曰此虚证而误投寒凉之药人肥而脉左大于右事急矣非加附子参术焉能有
急效再与一帖乃去附子作大剂与服至五十帖得大汗而愈自后又补养两月气体方始平复 一人五月内患谵语大发热肢体
不能举喜冷冻饮料诊其脉洪大而数用黄 茯苓浓煎如膏却用凉水调与之三四服后病者昏 如死状但颜色不改气息如常至次
早方醒诸证悉退而安 卢兄汗后再发热妄言吕仲修汗后热不退亦妄言陶明节热退后不识人言语谬妄皆用参 术归等补
剂而愈信哉谵语属虚者十居八九
阴证
手足冷脉细微而谵语用四逆汤活人用白通汤海藏用黄 加干姜汤
侯辅之脉极沉细外热内寒肩背胸胁斑出十数点语言狂乱或曰发斑谵语非热乎予曰非也阳为阴逼上入于肺传之皮毛
故斑出神不守舍故错语如狂非谵语也肌表虽热以手按之须臾冷透如冰与姜附等药数日约二十余两得大汗而愈后因再发
脉又沉迟三四日不大便与理中丸三日内约半斤其病全愈以此知侯公之狂非阳狂之狂乃失神之狂即阴虚也
诊 直视谵语喘满者死下利者亦死 谵语妄言身微热脉浮大手足温者生逆冷脉沉细者不过一日死矣
郑声
郑字书曰郑重频烦也又曰殷勤也郑声谓止将一事频烦殷勤言之盖神气不足不能更易而但守一声与谵语之错
出不伦者异矣此虚实之分也成氏以为郑卫之声迂而凿矣治法于前补虚条求之
吴 大抵郑声乃因内虚正气将脱而言皆不足之貌如手足并冷脉息沉细口鼻气息短少所语言语轻微无力气少难以
应
息者皆元气将脱也或吃逆不止神昏气促不知人事者死如气息不促手足颇温其脉沉细而微者急以附子渴倍人参主之或以
接气丹黑锡丹兼进一二服以助其真气或浓煎人参徐徐与之或未可用附子者以三白汤倍人参主之
戴 谵语属阳郑声属阴经云实则谵语虚则郑声谵语者颠倒错乱言出无伦常对空独语如见鬼状郑声者郑重频烦语
虽
谬而谆谆不已老年人遇事则谇语不休以阳气虚故也此谵语郑声虚实之所以不同也二者本不难辨但阳盛里实与阴盛隔阳
皆能错语须以他证别之大便秘小便赤身热烦渴而妄言者乃里实之谵语也小便如常大便洞下或发躁或反发热而妄言者乃
阳膈阳之谵语也里实宜下调胃承气汤热躁甚而妄言不休大渴喜饮宜理中汤热躁甚而妄言不休大渴喜饮宜理中汤阴隔阳
宜温理中汤又有不系正阳明似困非困间时有一二声谵语者此是汗出后津液不和慎不可下乃非阳非阴者宜小柴胡汤和建
中汤各半帖和荣卫通津液若阳传入阴自利手足厥逆语或错乱此虽已自利其中必有燥屎犹当下之阴中之阳宜调胃承气汤
瘀血在里大便黑小便利小腹痛其人如狂谵语者桃核承气汤妇人伤寒发热经水适断此热入血室其血必结亦能谵语宜小柴
胡汤病后血气未复精神未全多于梦寐中不觉失声如魇此不系谵语郑声宜温胆汤去竹茹入人参半钱或用六君子汤
（阳明病是胃肠实热证，胃气实则出现谵语，因此谵语应归入阳明病门类。）
成无己：谵语是指患者睡梦中或清醒时喃喃自语。另一种解释认为，谵语是指患者因幻觉而胡言乱语。这些都是因为胃中热盛，热气上冲于心，导致心神被热邪扰乱，从而出现神志昏乱、言语错谬的症状。轻者仅在睡眠中喃喃自语，重者即使清醒时也胡言乱语。经书所说的谵语、独语、狂语以及言语不休、语无伦次等情况，都是由热邪的轻重程度不同所致。（谵语错乱，若像与人交谈般有次序，或独自说话如见鬼魅，这是热邪较轻的表现；狂言不知人事，甚至喊叫且言语不休，这是热邪严重的表现；至于言语混乱，则是狂言骂人，不分亲疏，这说明神明已大乱，难以恢复其正常状态。）
谵语的成因各不相同，有的因火疗劫汗，有的因汗出过多，有的因下利，有的因下血，有的因胃中有燥屎，有的因三阳合病，有的因过经不解，有的因亡阳等。这些情况已在后文详细列出，此处不再赘述。此类病症若脉短则预后不良，脉象平和则痊愈。若身体微热、脉浮大者生，四肢逆冷、脉沉细者不过一日即死。或者气机上逆而喘满，或气机下夺而自利，均为逆证。
阳明胃实，潮热，宜用攻下法。
阳明病，出现谵语、发潮热，脉滑而疾速的，用小承气汤主治。给予小承气汤一盏，若腹中转动排气（失气），可再服一盏；若不转失气，则不要继续服用。明日若仍不大便，脉反而微涩的，说明里虚，属于难治之症，不可再给承气汤。
阳明病，谵语伴有潮热，反而不能进食的，说明胃中必有燥屎五六枚；若能进食，只是大便硬而已，宜用大承气汤攻下。
二阳并病，太阳病证候已罢，仅见发热、手足濈然汗出、大便困难且谵语的，攻下即可痊愈，宜用大承气汤。
阳明病，患者多汗，津液外泄导致胃中干燥，大便必然坚硬，硬则谵语，用小承气汤主治。若服一次后谵语停止，不要再服。
胃实汗多，宜用攻下法。
汗出且谵语的，说明胃中必有燥粪，此为风邪所致。必须等待表证已过（过经）才可攻下。若过早攻下，会导致语言错乱，这是因为表虚里实，所以攻下后可愈，宜用大承气汤。实证则谵语，虚证则郑声。（谵语是指言语错乱，没有定数，频繁更换话题；郑声是指郑重频烦，只重复说同一句旧话，终日殷勤而不换其他声音。这是因为神气有余则能机变而乱语，频繁更端；神气不足则无机变，只守一声。）
伤寒四五日，脉沉而喘满，沉主在里，却反用发汗法，导致津液越出，大便困难，表虚里实，日久则谵语。（成氏认为郑声是郑卫之声，这是错误的，前文已辩明。）
火疗后：
症状类似伤寒，但脉不弦紧而弱，脉弱者必口渴，若用火疗必致谵语。脉弱者发热，脉浮，解表当使汗出而愈。
太阳病用火劫汗法后，身黄、小便难、身体枯燥、头汗出、腹满微喘或不大便，日久则谵语。（相关论述见“头汗”条。）
太阳病第二天，反而烦躁，于是熨背大汗出，火热入胃，胃中津液枯竭，躁烦必发谵语。十余日后，振栗并自下利的，这是欲解之兆。
少阴病，咳嗽而下利，谵语，小便难的，是被火气劫汗所致。吐、下、汗、温针后出现谵语，若柴胡证已罢，此为坏病，需知犯何逆，以法治之。（详见坏证条。）
汗后：
伤寒脉浮，自汗，小便数，心烦，微恶寒，脚挛急，反用桂枝汤攻表，这是误治。若胃气不和出现谵语，少量给予调胃承气汤。（方论见“厥”条。）
三阳合病，腹满、身重、难以转侧、口不仁而面垢、谵语、遗尿。发汗则谵语加重；攻下则额上生汗、四肢逆冷。若自汗出的，用白虎汤主治。（论述见“身重”条。）
伤寒四五日，脉沉而喘满，沉为在里，反发其汗，津液越出，大便为难，表虚里实，日久则谵语，用大承气汤。（见“不大便”条。）
伤寒脉弦，头痛发热，属少阳病。少阳不可发汗，发汗则谵语。此属胃，胃和则愈，胃不和则烦而悸。（见少阳病条。）
发汗过多亡阳出现谵语的，不可攻下，给予柴胡桂枝汤调和营卫以通津液，之后自会出汗而愈。发汗过多，又重发汗，亡其阳，谵语，脉短者死，脉自和者不死。
各种逆证发汗，病轻者痊愈，病重者言语错乱、目眩者死。
下后：
伤寒八九日，误下后胸满、烦惊、小便不利、谵语、一身尽痛、不可转侧的，用柴胡加龙骨牡蛎汤。（方论见“惊”条。）
热入血室：
阳明病下血、谵语的，此为热入血室，仅头部出汗的，刺期门穴，随其实而泻之，自然汗出而愈。（腹满、谵语、脉浮紧的也刺期门。太阳少阳并病，发汗则谵语，脉弦，五六日谵语不止的，宜刺期门。）
妇人中风，发热恶寒，月经适来，得病七八日，热除脉迟，身凉，胸满如结胸状的，刺期门。若白天神志清楚，傍晚则谵语的，不要侵犯胃气及上二焦，必自愈。活人书主张用小柴胡汤主治。（论述见妇人伤寒条。）
伤寒十三日不解，过经谵语的，因为有热，应当用汤药攻下。若小便利的，大便应当硬，反而下利的，脉象调和的，知道医生是用丸药攻下的，这不是正确的治法。若自下利的，脉应当微厥，现在反而调和的，这是内实，用调胃承气汤主治。（成无己注：伤寒十三日，再传经尽谓之过经。谵语者是阳明胃热，应当用诸承气汤下之。若小便利，津液偏渗，大便应当硬，反下利的，知道医生用丸药下之。下利脉微而厥者为虚寒，今脉调和则非虚寒，由肠虚胃热协热而利，与调胃承气汤以下胃热。经文“内实”之“实”当作“热”。注：“偏渗”之“偏”当作“漏”。此段有五反：一是对热与厥反，二是汤与丸反，三是便硬与下利反，四是脉微与脉和反，五是药下与自利反。小便与大便硬为一对，读者宜细详之。）
上下利谵语，若脉调和、手足温、小便利的，属阳，故用承气汤下之。若脉当微厥及少阴但欲寐，被火气劫汗谵语、小便难的，属阴，故当用补剂和之。（但欲寐、下利、谵语俱见下利少阴条。）
许叔微：有人患伤寒下利，身热神昏，多困，谵语不得眠。有人见下利便以谵语为阴虚证。我说这也是小承气汤证。众人惊讶道：下利而服小承气汤，是仲景的法度吗？我说：这是仲景的法度。仲景云：下利而谵语者，有燥粪也，属小承气汤而得解。我曾读《素问》云：微者逆之，甚者从之。逆者正治，从者反治。从多从少，视其事也。帝曰：何谓反治？岐伯曰：塞因塞用，通因通用。王冰注云：大热内结，注泻不止，热宜寒疗，结复须除，以寒下之，结散利止，则通因通用也。正合于此。（又何疑焉？）
李东垣：大便秘，小便赤，手足温，脉洪数的，必谵语，用调胃承气汤。谵语不恶寒反恶热的，用白虎汤。已得汗，身和而谵语的，用柴胡桂枝汤。火迫而致谵语的，也用白虎汤。
张元素：治疗老幼及虚人伤寒，五六日昏冒，言语狂妄，小便或淋或涩，起卧无度，或烦而不得眠，并宜用白虎汤加山栀一钱。
刘完素：治疗热病及时疫，心躁狂乱，奔走状似癫痫，言语不定，久不得汗，及时疫不知人事者，取人中黄不拘多少，入罐内泥封固，武火半日，去火，候冷，取出于地上，以盆盖半日许，研如面粉，新汲水调下（三钱）。若未退，再服愈。（人中黄即屎也。）
吴又可：治疗伤寒热甚，心烦有痰，神昏谵语者，以竹沥一盏、生天花粉汁一盏服之，或加好金子三五钱同煎妙。按：此诸方内热不禁下者可用。
补虚：
《素问》云：谵语者，气虚独言也。（娄全善云：我用参、芪、归、术等剂治疗谵语痊愈者百十数，岂可不分别虚实，一概用黄连解毒汤、大小承气汤等治疗呢？）《难经》云：脱阳者见鬼。（仲景谓亡阳谵语亦此义。）
张元素：黄汤治疗伤寒或时悲哭，或时嬉笑，或时太息，或语言错乱失次，世人疑作谵语狂言者，非也，盖神不守室耳。两手脉浮沉不一，举按全无力，浮之损小，沉之亦损小，皆阴脉也。病甚者用调中丸或理中丸。（方见前补养条。）
朱丹溪：浦江郑兄年二十岁，九月间发热头痛，妄言见鬼，医与小柴胡汤数帖，热愈甚。予视之，形肥面色带白，却喜筋骨稍露，诊其脉弦大而数实。脉本不实，乃凉药所致。此因劳倦成病，与温补药自安。遂以参、术为君，苓、芍为臣，黄芪为佐，附子一片为使，与一帖而证不减。或曰：脉既数大，狂热而又大渴，用附子误矣。予曰：此虚证而误投寒凉之药，人肥而脉左大于右，事急矣，非加附子、参、术焉能有急效？再与一帖，乃去附子，作大剂与服，至五十帖得大汗而愈。自后又补养两月，气体方始平复。一人五月内患谵语，大发热，肢体不能举，喜冷冻饮料，诊其脉洪大而数，用黄芪、茯苓浓煎如膏，却用凉水调与之，三四服后病者昏愦如死状，但颜色不改，气息如常，至次早方醒，诸证悉退而安。卢兄汗后再发热妄言，吕仲修汗后热不退亦妄言，陶明节热退后不识人，言语谬妄，皆用参、芪、术、归等补剂而愈。信哉！谵语属虚者十居八九。
阴证：
手足冷，脉细微而谵语，用四逆汤。活人书用白通汤。海藏用黄芪加干姜汤。
侯辅之：脉极沉细，外热内寒，肩背胸胁斑出十数点，语言狂乱。或曰：发斑谵语非热乎？予曰：非也。阳为阴逼，上入于肺，传之皮毛，故斑出。神不守舍，故错语如狂，非谵语也。肌表虽热，以手按之，须臾冷透如冰。与姜、附等药数日，约二十余两，得大汗而愈。后因再发，脉又沉迟，三四日不大便，与理中丸，三日内约半斤，其病全愈。以此知侯公之狂，非阳狂之狂，乃失神之狂，即阴虚也。
诊法：
直视谵语，喘满者死；下利者亦死。谵语妄言，身微热，脉浮大，手足温者生；逆冷，脉沉细者，不过一日死矣。
郑声：
《郑字书》曰：郑重频烦也，又曰殷勤也。郑声谓止将一事频烦殷勤言之。盖神气不足，不能更易，而但守一声，与谵语之错出不伦者异矣。此虚实之分也。成氏以为郑卫之声，迂而凿矣。治法于前补虚条求之。
吴又可：大抵郑声乃因内虚正气将脱而言，皆不足之貌。如手足并冷，脉息沉细，口鼻气息短少，所语言语轻微无力，气少难以应息者，皆元气将脱也。或呃逆不止，神昏气促，不知人事者死。如气息不促，手足颇温，其脉沉细而微者，急以附子、倍人参主之。或以接气丹、黑锡丹兼进一二服以助其真气。或浓煎人参徐徐与之。或未可用附子者，以三白汤倍人参主之。
戴元礼：谵语属阳，郑声属阴。经云：实则谵语，虚则郑声。谵语者，颠倒错乱，言出无伦，常对空独语，如见鬼状。郑声者，郑重频烦，语虽谬而谆谆不已。老年人遇事则谇语不休，以阳气虚故也。此谵语、郑声虚实之所以不同也。二者本不难辨，但阳盛里实与阴盛格阳皆能错语，须以他证别之。大便秘，小便赤，身热烦渴而妄言者，乃里实之谵语也。小便如常，大便洞下，或发躁或反发热而妄言者，乃阳格阳之谵语也。里实宜下调胃承气汤。热躁甚而妄言不休，大渴喜饮，宜理中汤。热躁甚而妄言不休，大渴喜饮，宜理中汤。阴隔阳宜温理中汤。又有不系正阳明，似困非困，间时有一二声谵语者，此是汗出后津液不和，慎不可下，乃非阳非阴者，宜小柴胡汤、建中汤各半帖，和营卫，通津液。若阳传入阴，自利，手足厥逆，语或错乱，此虽已自利，其中必有燥屎，犹当下之，阴中之阳，宜调胃承气汤。瘀血在里，大便黑，小便利，小腹痛，其人如狂，谵语者，桃核承气汤。妇人伤寒发热，经水适断，此热入血室，其血必结，亦能谵语，宜小柴胡汤。病后血气未复，精神未全，多于梦寐中不觉失声如魇，此不系谵语郑声，宜温胆汤去竹茹入人参半钱，或用六君子汤。
(Mingyang disease refers to the excess syndrome of the stomach and intestines. When the stomach qi is in excess, delirium occurs; therefore, delirium should be classified under Mingyang disease.)
Cheng Wuji: Delirium (Shanyu) refers to muttering speech during sleep or while awake. Another interpretation suggests that delirium refers to nonsensical speech caused by hallucinations. These conditions arise because excessive heat in the stomach rises to affect the heart, disturbing the spirit (Shen), leading to confusion and erroneous speech. In mild cases, there is only muttering during sleep; in severe cases, nonsensical speech occurs even when awake. The classics mention delirium, solitary talking, manic speech, continuous speech, and incoherent speech as resulting from varying degrees of heat pathogen severity. (Delirious and confused speech, if occurring with some order like conversing with others, or speaking alone as if seeing ghosts, indicates a milder heat pathogen. Manic speech with loss of consciousness, even shouting and continuous speech, indicates severe heat. Incoherent speech involves cursing and insulting without distinction between kin and strangers, indicating that the spirit is severely disturbed and difficult to restore.)
The causes of delirium vary. Some result from fire therapy forcing sweat, some from excessive sweating, some from diarrhea, some from bleeding, some from dry feces in the stomach, some from concurrent diseases of three Yang meridians, some from passing through stages without resolution, and some from collapse of Yang qi. These situations are detailed later, so they are not repeated here. In such cases, if the pulse is short, the prognosis is poor; if the pulse is harmonious, recovery is expected. If the body has slight fever and the pulse is floating and large, life is preserved; if limbs are cold and the pulse is sunken and fine, death may occur within a day. Alternatively, rebellious Qi causing wheezing and fullness, or sinking Qi causing spontaneous diarrhea, are all adverse signs.
Mingyang stomach excess with tidal fever requires purgation.
In Mingyang disease, with delirium and tidal fever, and a slippery and rapid pulse, Xiao Chengqi Tang (Minor Order the Stomach Decoction) is the primary treatment. Administer one cup of Xiao Chengqi Tang. If gas moves in the abdomen (shifting wind), administer another cup; if no gas moves, do not continue administration. If the next day there is still no bowel movement and the pulse becomes slightly choppy and coarse, it indicates interior deficiency, which is difficult to treat; do not administer Chengqi decoctions again.
In Mingyang disease, with delirium and tidal fever, if the patient cannot eat, it indicates dry feces in the stomach; if the patient can eat, the stool is merely hard. Da Chengqi Tang (Major Order the Stomach Decoction) should be used for purgation.
In concurrent disease of two Yang meridians, after Taiyang symptoms resolve, presenting only with fever, continuous sweating on hands and feet, difficulty in defecation, and delirium, purgation leads to cure; Da Chengqi Tang is indicated.
In Mingyang disease, if the patient sweats excessively, fluids exit, causing stomach dryness and hard stools, leading to delirium, Xiao Chengqi Tang is the primary treatment. If delirium stops after one dose, do not administer further.
Stomach excess with profuse sweating requires purgation.
Sweating accompanied by delirium indicates dry feces in the stomach due to wind pathogen. Purgation must wait until the exterior stage has passed. Premature purgation leads to language disorder because the exterior is deficient and the interior is excess; thus, purgation leads to cure, and Da Chengqi Tang is indicated. Excess leads to delirium; deficiency leads to Zhengsheng (repetitive speech). (Delirium refers to chaotic speech without pattern, frequently changing topics. Zhengsheng refers to earnest and repetitive speech, repeating the same phrase continuously. This is because abundant spirit allows for variability and chaotic speech, while deficient spirit lacks variability and repeats only one sound.)
In Cold Damage four to five days ago, with a sunken pulse and wheezing/fullness, sunken indicates interior location, but contrary use of diaphoresis causes fluid loss, difficulty in defecation, exterior deficiency and interior excess, leading to delirium over time. (Cheng believed Zhengsheng referred to Zheng-Wei sounds, which is incorrect, as clarified previously.)
Post-fire therapy:
Symptoms resemble Cold Damage, but the pulse is not wiry-tight but weak. Weak pulse implies thirst; fire therapy will definitely cause delirium. Weak pulse with fever and floating pulse indicates resolution through sweating.
After Taiyang disease undergoes fire-induced sweating, presenting with yellow skin, difficult urination, dry body, head sweating, abdominal fullness, slight wheezing, or constipation, long-term delirium may occur. (See "Head Sweating" section.)
On the second day of Taiyang disease, irritability appears; back ironing causes profuse sweating, fire heat enters the stomach, depletes stomach fluids, causing irritability and delirium. After ten-plus days, trembling and spontaneous diarrhea indicate impending resolution.
Shaoyin disease with cough, diarrhea, delirium, and difficult urination results from fire Qi forcing sweat. After vomiting, purging, sweating, or warm needle therapy, if delirium occurs and Chaihu syndrome resolves, this is a damaged disease; treat according to the deviation. (See Damaged Syndrome section.)
Post-sweating:
Cold Damage with floating pulse, spontaneous sweating, frequent urination, mental restlessness, slight aversion to cold, and cramped legs, treated incorrectly with Guizhi Tang (Cinnamon Twig Decoction) to attack the exterior. If stomach Qi disharmony causes delirium, give small amounts of Tiaowei Chengqi Tang (Regulate the Stomach Order the Stomach Decoction). (Formula discussion in "Jue" section.)
Concurrent disease of three Yang meridians presents with abdominal fullness, heaviness, difficulty turning, insensitivity around the mouth, greasy face, delirium, and urinary incontinence. Diaphoresis worsens delirium; purgation causes sweating on the forehead and cold limbs. If spontaneous sweating occurs, Baihu Tang (White Tiger Decoction) is indicated. (Discussion in "Body Heaviness" section.)
Cold Damage four to five days ago, with sunken pulse and wheezing/fullness, sunken indicates interior, but contrary diaphoresis causes fluid loss, difficulty in defecation, exterior deficiency and interior excess, leading to delirium; Da Chengqi Tang is indicated. (See "Constipation" section.)
Cold Damage with wiry pulse, headache, and fever belongs to Shaoyang. Shaoyang should not be diaphoresed; diaphoresis causes delirium. This belongs to the stomach; if stomach harmonizes, cure ensues; if not, irritability and palpitations occur. (See Shaoyang Disease section.)
Excessive sweating leading to Yang collapse with delirium should not be purged; instead, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) harmonizes Ying and Wei to unblock fluids, leading to natural sweating and cure. Repeated sweating causing Yang collapse with delirium and short pulse indicates death; harmonious pulse indicates survival.
Adverse conditions treated with sweating: mild cases recover; severe cases with language disorder and dizziness die.
Post-purging:
Cold Damage eight to nine days, mistreated with purgation, presenting with chest fullness, fright, difficult urination, delirium, whole-body pain, and inability to turn, use Chaihu Jia Longgu Muli Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction). (Formula discussion in "Fright" section.)
Heat Entering the Blood Chamber:
Mingyang disease with bleeding and delirium indicates Heat Entering the Blood Chamber. Only head sweating occurs; puncture Qimen (LR14) to drain excess. Natural sweating leads to cure. (Abdominal fullness, delirium, floating-tight pulse also indicate Qimen puncture. Concurrent Taiyang-Shaoyang disease, diaphoresis causes delirium, wiry pulse, delirium persisting five to six days, puncture Qimen.)
Women with Wind Strike, fever, aversion to cold, menstruation arriving, seven to eight days later, heat subsides, pulse slow, body cool, chest full like Tie Xiong syndrome, puncture Qimen. Clear mind by day, delirium by night; do not violate Stomach Qi or Upper Jiao, self-resolution expected. Huoren Shu recommends Xiao Chaihu Tang (Minor Bupleurum Decoction). (Discussion in Women's Cold Damage section.)
Cold Damage unresolved for thirteen days, passing stages with delirium indicates heat; purgation with decoction is required. If urination is clear, stool should be hard; if diarrhea occurs instead and pulse is harmonious, the physician likely used pill-based purgatives, which is incorrect. If spontaneous diarrhea occurs and pulse should be faint/cold but is harmonious, this is interior excess; Tiaowei Chengqi Tang is indicated. (Cheng Wuji notes: Passing stages means completing transmission cycles. Delirium indicates Mingyang stomach heat; purge with Chengqi decoctions. Clear urination diverts fluids, stool should be hard; diarrhea suggests pill purgatives. Faint/cold pulse indicates deficiency-cold; harmonious pulse rules this out. Interior heat with diarrhea requires Tiaowei Chengqi Tang to clear stomach heat. "Interior excess" implies heat. "Biased seepage" implies leakage. Five contradictions exist: heat vs. cold, decoction vs. pill, hard stool vs. diarrhea, faint vs. harmonious pulse, medicated vs. spontaneous diarrhea. Readers should analyze carefully.)
Diarrhea with delirium: Harmonious pulse, warm extremities, clear urination indicate Yang; use Chengqi purgation. Faint/cold pulse, Shaoyin desire to sleep, fire-induced delirium, difficult urination indicate Yin; use tonifying harmonizing formulas. (Desire to sleep, diarrhea, delirium see Shaoyin Diarrhea section.)
Xu Shumi: A patient with Cold Damage diarrhea, fever, confusion, lethargy, delirium, and insomnia was diagnosed with Yin deficiency by some. I stated this is Xiao Chengqi Tang syndrome. Others questioned using purgatives for diarrhea. I cited Zhang Zhongjing: Diarrhea with delirium indicates dry feces; Xiao Chengqi Tang resolves it. Citing Suwen: Treat mild cases oppositely, severe cases similarly. Zhengzhi (direct treatment) vs. Fan Zhi (contrary treatment). Wang Bing注释: Internal heat binding causes diarrhea; cold clears heat and binding. Once bound disperses, diarrhea stops; Tong Yin Tong Yong (treat obstruction with unblocking method) applies.
Li Dongyuan: Constipation, red urine, warm extremities, surging-rapid pulse indicate delirium; Tiaowei Chengqi Tang. Delirium without aversion to cold but with aversion to heat; Baihu Tang. Post-sweating, body harmonious but delirious; Chaihu Guizhi Tang. Fire-forced delirium; Baihu Tang.
Zhang Yuansu: For elderly, children, and deficient persons with Cold Damage, five to six days of coma, wild speech, dysuria or retention, restlessness, insomnia; Baihu Tang plus Gardenia (one qian).
Liu Wansu: For febrile diseases and epidemics with mental agitation, mania, running, epilepsy-like state, unstable speech, prolonged lack of sweat, or unconsciousness in epidemics; use Renzhonghuang (Manure Yellow) sealed in clay pot, fired for half a day, cooled, ground to powder, mixed with fresh water (three qian). Repeat if necessary. (Renzhonghuang is human excrement.)
Wu Youke: For severe Cold Damage heat, irritability, phlegm, confusion, delirium; Bamboo Sap (one cup) plus raw Tianhuafen juice (one cup), or add Gold (three to five qian) and decoct. Note: Applicable for internal heat intolerant of purgation.
Tonifying Deficiency:
Suwen states: Delirium is due to Qi deficiency and solitary speech. Lou Quanshan noted successful treatments with Ginseng, Astragalus, Angelica, Atractylodes, questioning the indiscriminate use of Coptis Decoction or Chengqi formulas without distinguishing deficiency/excess. Nan Jing states: Collapse of Yang leads to seeing ghosts. Zhang Zhongjing's Yang collapse delirium shares this meaning.
Zhang Yuansu: Huang Tang treats Cold Damage with alternating crying/laughing, sighing, or disordered speech. People mistake this for delirium/manic speech, but it is actually spirit not residing in its chamber. Pulse floating/sinking inconsistent, weak upon pressure, both superficial and deep pulses diminished indicate Yin pulse. Severe cases use Tiaozhong Wan or Lizhong Wan. (Formulas in Tonification section.)
Zhu Danxi: Brother Zheng of Pujiang, age 20, September fever, headache, hallucinating ghosts, treated with Xiao Chaihu Tang multiple doses, heat worsened. Examination: Fat, pale complexion, prominent bones, wiry-large-rapid-solid pulse. Pulse was not truly solid but caused by cold medicines. Illness due to fatigue; treated with warm tonics. Formula: Ginseng, Atractylodes (monarch), Poria, Peony (ministers), Astragalus (assistant), Aconite (envoy). One dose showed no improvement. Critics argued against Aconite due to rapid pulse, high fever, and thirst. I replied: This is deficiency mistaken for excess by cold meds. Urgent case requires Aconite and Ginseng/Atractylodes for quick effect. Second dose removed Aconite, increased dosage. After fifty doses, profuse sweating cured him. Two months of tonification restored health. Another case: May delirium, high fever, immobility, craving cold drinks, surging-rapid pulse. Astragalus and Poria decocted thick, taken with cold water. Three doses led to coma-like state but normal color/breath; woke next morning, symptoms resolved. Lu, Lv, Tao post-sweating delirium/confusion cured with Ginseng, Astragalus, Atractylodes, Angelica tonics. Indeed, 80-90% of delirium cases are deficiency.
Yin Syndrome:
Cold extremities, fine-subtle pulse with delirium; Sini Tang (Reverse the Extremity Decoction). Huoren Shu uses Bitong Tang. Haizang uses Astragalus plus Ginger.
Hou Fuzhi: Extremely sunken-fine pulse, external heat/internal cold, spots on shoulders/back/chest, manic speech. Some thought spotted delirium was heat. I said: No. Yang forced by Yin up into Lung, transmitting to skin, causing spots. Spirit unsettled causes manic speech, not true delirium. Skin hot but cold to touch. Treated with Ginger/Aconite for days (approx. 20 liang), profuse sweating cured. Recurrence with sunken-slow pulse, constipation; Lizhong Wan cured. Hou's mania was spirit loss (Yin deficiency), not Yang mania.
Diagnosis:
Fixed gaze, delirium, wheezing/fullness indicate death. Diarrhea also indicates death. Delirium, slight fever, floating-large pulse, warm extremities indicate survival. Cold limbs, sunken-fine pulse indicate death within a day.
Zhengsheng (Repetitive Speech):
Dictionaries define Zheng as earnest/repetitive. Zhengsheng is repeating one topic earnestly due to insufficient spirit energy, unable to change, unlike delirium's chaos. This distinguishes deficiency from excess. Cheng's view of Zheng-Wei sound is flawed. Treatment follows the Tonifying Deficiency section.
Wu Youke: Generally, Zhengsheng results from internal deficiency and impending Qi collapse. Signs include cold extremities, sunken-fine pulse, short breath, weak speech, inability to respond. All indicate collapsing Yuan Qi. Incontinence, coma,急促 breathing indicate death. If breathing not急促, warm extremities, sunken-fine-micro pulse, urgently use Aconite and double Ginseng. Or Jieqi Dan/Heixi Dan. Or concentrated Ginseng tea. If Aconite unsuitable, Sanbai Tang with double Ginseng.
Dai Yuanli: Delirium is Yang; Zhengsheng is Yin. Classics: Excess delirium, deficiency Zhengsheng. Delirium is chaotic, incoherent, talking to air like seeing ghosts. Zhengsheng is earnest repetition. Elderly rambling due to Yang deficiency. Distinguishing them is easy, but Yang excess interior excess and Yin excess blocking Yang can both cause disordered speech; differentiate by other signs. Constipation, red urine, fever, thirst, wild speech = interior excess delirium; purgative Tiaowei Chengqi Tang. Normal urination, loose stool, irritability/fever, wild speech = Yang blocking Yang delirium; warm Lizhong Tang. Non-Mingyang, intermittent delirium post-sweating due to fluid disharmony; do not purge. Use Chaihu Tang and Jianzhong Tang halves to harmonize Ying/Wei. Yang transmitting to Yin, diarrhea, cold limbs, disordered speech; though diarrhea, dry feces remain; purge Yin-within-Yang with Tiaowei Chengqi Tang. Blood stasis in interior, black stool, clear urination, lower abdominal pain, mania-like delirium; Taohhe Chengqi Tang. Women Cold Damage fever, menstruation stopping, Heat Entering Blood Chamber, blood binding, delirium; Xiao Chaihu Tang. Post-illness Qi/Spirit incomplete, dream voice loss like sleep paralysis; not delirium/Zhengsheng; Wendan Tang minus Scutellaria/Bamboo Sap plus Ginseng, or Liujunzi Tang.